Laserfiche WebLink
BACKWATER PRENENTIG�N PROGRAM <br />INVOICE COS"i" BREAK�OW!d <br />Please use this Invoice Cost Breakdown as .:� template for invoices submitted as part of ihe Backwater <br />Prevention Device rebate program. Either this fortn or your o•�vn invoice fortn with the following line items qn <br />be submitted. This allows you to invoice your client accordinc� to your existing billiny template wliile allowing <br />city staff to identify how costs eli3ible for the Backwater Prevention Device Re�ate were accruecl. <br />Only labor and materlals directly related to the installation and lunction ol a backwater prevention <br />device are eligibfe lor Clty rebate and therefore shoufd ,be Included on tix: upper hall o/ this /ortn. <br />Additional costs may be added to bottom of the lomi. <br />Business Name: Y'�l��L�YY1,�i I�Li t(..L License Number. _,��{��� f�mi��� <br />Business Mailing Address: �� C( (L(,C'f'u-rQ-r1 Lc�, i`�Y1r" Fl�le-�- kY4 `��-�C <br />Ciry State Zip <br />Phone: ��-5— ��' �— D�Z�� Email:�����w� b I�' `� LLC ��_ �[�Y1'?^ 1't�t __ <br />- �.... ,-5�_. i_ _. � <br />Administration <br />Labor <br />Matcrials <br />Othcr Costs <br />Administration 1 <br />CCN Inspec6o <br />BWV Install <br />Surtace restora6on <br />Site cleanup <br />Downspouts / drainage ii <br />Backwatervalve <br />Grinder pump <br />Side sewer pipe (up l0 8 <br />Imported Backfill <br />Surface RestoraHon Mat <br />ro soil, gress seed, cor <br />Cover iirriqation box or h <br />Delivery fees if not covered by labor <br />Costs not assaciated with BWD, and <br />Revised 9/03::2014 <br />Hours <br />Hours <br />Hours <br />Hours <br />Per Unit <br />Per U�il <br />Yards L <br />Lump � <br />sum <br />Per Unit � <br />Hour <br />_ � <br />$ <br />5 <br />�� <br />� <br />